Provider Demographics
NPI:1346338340
Name:FARRELL, LYNDA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:ANN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 POST RD
Mailing Address - Street 2:SUITE M7
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1618
Mailing Address - Country:US
Mailing Address - Phone:201-337-9498
Mailing Address - Fax:201-337-9031
Practice Address - Street 1:9 POST RD
Practice Address - Street 2:SUITE M7
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1618
Practice Address - Country:US
Practice Address - Phone:201-337-9498
Practice Address - Fax:201-337-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA038145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0721000Medicaid
222430739OtherFEDERAL TAX ID
NJFA445839Medicare ID - Type Unspecified
222430739OtherFEDERAL TAX ID